Dr. Allen I was hoping you could help me with my Achilles Tendon Injury! See my history below.
I’ve had a very long-standing Achilles Tendon Injury (since April 2012), coinciding with a piriformis/gluteus issue on the same side (chiropractors have seemed to suggest that this messes up my gait and makes it crooked; perhaps this contributes to the Achilles trouble). I’m in my 20’s still, used to run around 60-70 miles weekly, but messed up the Achilles somehow several years ago, and it’s never healed. I’ve tried all well-known Achilles remedies: Graston, ART, eccentrics, ice, heat, massage, total rest, myofascial, etc. Many gave temporary relief, but none permanent. Recently I had an MRI to get a clearer picture; the report stated that the Achilles Tendon had “mild fusiform thickening and minimal edematous change within the substance of the Achilles…fluid in the retrocalcaneal bursa…mild edematous change in Kager’s fat pad [and] patchy high signal intensity through the ossesous structures…given patient history of running, this is consistent with the level of activity.” Everything else–“anterior and posterior ligaments, medial, lateral, and anterior tendons, etc.”–was normal, no fractures or bony contusions, paratenon preserved, etc.
Good. If we assume the MRI is of quality and that the radiologist that read it is competent then you have no tear. This is good news. However, you obviously still have an Achilles Tendon Injury. From the description the MRI is saying you have TENDONOSIS/TENDONOPATHY My guess then is that although you had treatment somehow your case was not managed correctly and your issue continued to cause you problems.
I’ve recently started getting some dry needling treatments, which seem to help the Achilles Tendon Injury. For about a year I would run perhaps 20 minutes three times a week; the doctor doing the needle treatment advised me to try longer distances (8-10 miles) to see if it holds up, and I was able to do this several times without substantial discomfort.
Again this is good news. If you can run 8-10 miles several times “without substantial discomfort” then it seems as if your Achilles Tendon Injury is close to being 100%.
An orthopedist suggested to me a tenolysis procedure, which I had scheduled for two weeks from now. My options seemingly are to do nothing and live with it (which would probably end my competitive running), to continue sessions of dry needling indefinitely (which might need many times to see results), or to get the “tenolysis.” I have a job requiring me to stand all day, and no car, so getting this procedure would be very disruptive, and perhaps my situation would jeopardize the healing. I am also reluctant to do it unless there was a near-guarantee that I would return to full activity; as a former competitive runner, wishing to return to it, it would not seem worth it to get a surgery and then be limited only to casual jogging a few times a week.
If you were able to run 8-10 miles without substantial discomfort after all these years why would you even consider a surgery? Why not start cutting back on the dry needling and keep increasing your running slowly and steadily?
I’m wondering what you would advise in light of my above description, whether to go ahead with the surgery or put it off and hope for a cure from something else, like the dry needling. I appreciate any help or advice you have. Thank you.
A few questions for you. How old are you? Age makes a huge difference when considering how long something might take to heal.
How many sessions has the person doing the dry needling suggested? It seems you implied you would have to do it “Indefinitely”. Did the doctor not outline a treatment plan?
Do shoes or orthotics make any difference in your pain? Perhaps you have a biomechanical reason for this injury. Shoes and/or orthotics might help to make a difference if that is the case.
Why kind of running shoes do you wear? Certain shoe types known as “O-Drop” shoes could influence the condition for the better or worse.
What types of surfaces do you run on? Does it make a difference? For example; running in sand requires more muscular effort from the calf and achilles and could contribute to the problem.
Do you do any activity besides running for exercise? For example; you might be trying to rehabilitate the injury doing an activity that is actually contributing to the problem such as box jumps.
The more information I have the more likely i can help you. Email me at firstname.lastname@example.org or text 858-322-8581 for an appointment.